Getting to the heat of the matter

Saturday, 28 l 05 l 2011 Source: The Straits Times

By: Andy Ho

NOTING that I had been laid low again bymy recurring lumbago, my sister gave mesome self-heating “moxa” pads whichshe had bought when she was last inSeoul.They were as good as real moxibustion, she said,referring to a form of therapy in traditional Chinesemedicine (TCM) that uses heat generated by burninga herb to stimulate acupuncture points.The small, spongy herb used is called mugwort orArtemisia vulgaris. The therapy is called moxibustion,meaning combustion of moxa, a monickerderived from the Japanese mogusa (with the “u” veryshort, thus mogsa or moxa).

The Korean self-heating pads were bags of moxa,charcoal and an oxygen-sensitive system. When abag is opened and the ingredients shaken, the systemheats up. Within minutes, the bag is a comfortable 70deg C or thereabouts and stays like that for hours.Applied to acupuncture points, it supposedlyheals what ails one. Applied to sore muscles directly,it definitely affords some pain relief.In classical moxibustion, the idea is to use heatto warm certain acupuncture points to stimulatethe circulation of the qi or life force, so it flows freelyaround in your body.In TCM, if qi flows freely,health obtains. If the flow is blocked, however, illhealth results.

The aim in TCM is to get qi flowing smoothlyagain in a sick person and moxibustion is one modeof doing so.Sometimes a therapist puts a small cone of processedmoxa on an acupuncture point and lights itup. But just before the moxa actually burns down tothe skin, he deftly pinches it away.The heat thus generated penetrates into the acupuncturepoint to do its magic. A Seoul NationalUniversity of Technology study published in theJournal of Mechanical Science and Technology lastyear reported that this heat penetrates 5mm intothe skin.In past times, some therapists would actuallyallow the moxa to burn down to the skin, whichwould blister and heal with scarring.

An 18th centuryeyewitness account written by Engelbert Kaempfercalled Moxa in China and Japan noted that moxapowder about as much as half a grain of rice wasburned directly on the skin. (It was this treatisethat gave the technique its present name in English.)Because moxibustion was easier to do than acupuncture,it became widely used as folk medicine somuch so that Kaempfer said he met no Japanesewho did not have some moxa scarring.

Another methodcurrently used is toburn moxa fluffwrapped around theends of acupunctureneedles alreadyinserted into theskin. These metallicneedles conduct theheat down into therelevant acupuncturepoints.Otherwise, a(non-smokable)moxa cigar is lit andthe smoulderingstick held near to theappropriate acupuncturepoints oraround acupunctureneedles if alreadyinserted. Thisismaintained for a fewminutes until theskin turns red.But does it work?

There are to befound in the Western and East Asian medical literaturemany studies addressing this issue in a varietyof conditions. There have also been several systematicreviews of such studies.In the last few years, researchers from the KoreaInstitute of Oriental Medicine have done several systematicreviews of these studies that looked at theeffectiveness of moxibustion in stroke rehabilitation,hypertension, ulcerative colitis, rheumatoidarthritis, osteoarthritis, diabetes, asthma, cancerand constipation.The Korean reviews were published in variousjournals and all said that the quality of the primarystudies was so bad, methodologically speaking, nofirm conclusions could be drawn.

This unflattering conclusion is akin to that of a2009 study published in Trials that looked at themethodological shortcomings of clinical trials publishedin Chinese journals. Scientists fromChengdu, Hong Kong and Ottawa working togetherlocated 1,685 studies of TCM therapies said to berandomised controlled trials.They interviewed the authors only to find under7 per cent were truly randomised controlled trials.Most of these Chinese researchers did not knowhow to design a rigorous clinical trial, they said.The study concluded “that so many non-randomisedcontrolled trials... published as randomizedcontrolled trials reflected the fact thatpeer review needs to be improved” in Chineseresearch.

So the fairest thing that can be said about moxibustionat this juncture is that we have no proof yetthat it works.This is sad since it has been used for at least wellover a millennium. We know this because, a centuryago, some Buddhist manuscripts discovered in acave at Dunhuang along the Silk Road innorth-western China were found to contain sketchesof the human body. These turned out to be moxibustioncharts dating from the Tang dynasty(AD618 to 907). The charts are now held in the BritishMuseum.Hopefully, we will not have to wait another centuryfor Chinese science to ascertain if moxibustion actually works.